Innate immunity mediating inflammation secondary to endotracheal intubation

Abstract

Objective: To investigate the inflammatory markers associated with short-term endotracheal intubation in healthy surgical patients.

Design: An observational and prospective study of subjects scheduled for same-day surgery procedures.

Setting: Level I trauma center.

Patients: Fourteen healthy patients intubated for same-day surgery procedures. The median duration of surgery was 3 hours.

Interventions: Serial lavages above the tracheal cuff were obtained at the beginning of surgery, at 1 hour, and at the end of surgery; samples were assayed for cellular counts and levels of cytokines and complement 5a (C5a).

Results: The total number of polymorphonuclear cells (PMNs) increased almost 10-fold from intubation to extubation (P < .01). The levels of 3 of the cytokines measured in tracheal lavage supernatants were significantly elevated over the time of intubation: tumor necrosis factor (TNF) (P < .01), interleukin 6 (IL-6) (P < .01), and IL-1β (P < .025). Levels of IL-8 showed an upward trend over time but were not significantly increased; C5a levels were significantly elevated over time (P < .05).

Conclusions: Short-term intubation in healthy patients resulted in significant tracheal inflammation. Involvement of the innate immune system as documented in the present study provides information that may help to better understand the pathophysiologic characteristics of subglottic stenosis and other endotracheal injuries secondary to endotracheal intubation.